Postthoracotomy pulmonary function: A comparison of epidural versus intravenous meperidine infusions

L’ajout d’adrénaline à la mépéridine péridurale thoracique n’améliore pas l’analgésie à la suite d’une thoracotomie

“…Previous research comparing intravenous and epidural meperidine use 48 hr after thoracotomy identified serum normeperidine levels approximately 0.2 µg·mL -1 following consumption of approximately 1000 mg of meperidine. 24 Symptoms of neuroexcitation including "shakiness and/or tremors" occurred only in those patients with levels > 0.3 µg·mL -1 . 24 We were unable to demonstrate any measurable serum normeperidine levels in either study group raising the possibility of measurement error.…”

“…24 Symptoms of neuroexcitation including "shakiness and/or tremors" occurred only in those patients with levels > 0.3 µg·mL -1 . 24 We were unable to demonstrate any measurable serum normeperidine levels in either study group raising the possibility of measurement error. We were, however, reassured by the clinical chemist who commented that the assay was appropriate and that "if any (normeperidine) was present it was at a level 50-fold below the dynamic range of the assay which was from 0.005 to 1.0 µg·mL -1 ."…”

Epidural clonidine, bupivacaine or methadone as the sole analgesic agent after thoracotomy for lung resection

“…There is little evidence to suggest that significant, though fairly mild (10-15%), improvements in pulmonary function can result in reduced morbidity. Slinger et al [20] reported improved post-thoracotomy pulmonary function, better analgesia scores and reduced pulmonary morbidity in patients treated with epidural meperidine compared to intravenous meperidine. Nakahara et al [21] found that a difference of 10% in post-thoracotomy FEV 1 separated high risk patients from those at low risk of postoperative respiratory failure.…”

Anaesthesia for thoracic surgery in children

“…There are proponents of epidural opioid administration, and there are those who believe that the risks, particularly of respiratory depression outweigh the advantages. Thoracic epidural opioid infusion after thoracotomy allows better recovery of respiratory function in adults than does intravenous opioid administration ( 120,121). This remains to be substantiated in children.…”